Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
The Medical Bell Curve
As with most Ricochetti, one of @drbastiat ‘s posts, Strange Things Aren’t Getting Better, got me a-thinkin’. Yeah, I know. A-thinkin’ isn’t my best look. The Lovely and Talented Mrs. Mongo probably echoes your thoughts. She has told me numerous times, “Honey, go do something physical or dynamic or ballistic. Go beat somebody up, or shoot up something, or blow something up, but in the interest of all that is good in this world, don’t set yourself to a-thinkin’.”
Too late.
Doc lays out the trials and tribulations of Karen, the treating of whom is a nightmare (even a layman like me can see that), and, per Doc and many of the comments, sets the predicate for being a problem child of epic dimensions by saying, “I know my body.” Yeah. I get it. Anyone that would choose a crystal bracelet over ibuprofen for a sprained wrist is suspect. Still…
I know my body.
I think that most docs (and I certainly encourage any medical subject matter expert to chime in) after years of treating different people with wildly different maladies, find that their patients’ response to and compliance with their doctors’ instructions fall into a bell curve. I further posit that they get used to thinking that the 70-90% of their patients that make up that big ol’ swell in the bell curve are every patient that walks into their exam room. Outliers are not taken into account.
I’m only going to use personal examples, not because I’m a self-involved egoist who thinks everything is, ultimately, about me (I am and I do), but because with The Lovely and Talented Mrs. Mongo (aka Supernurse) is a clinical risk manager. Heaven forfend that anyone think, from my supplying hypothetical anecdotes that there were ever any pillow talk that violated HIPAA–or, as the Lovely and Talented Mrs. Mongo prefaces about every conversation with, “hippa, hippa, hippa.”
[Aside: Can you imagine the pain to the gluteus maximus when one half of a couple ensconced in marital bliss is in Special Operations, swaddled in OPSEC and NDAs and National Security stuff, and the other is a medical professional who takes HIPAA very, very seriously?
“Hey, honey,” I’d hear upon coming home, “how was your time x? (your time x = the day/week/month/year you were gone)”
“Fine. How was yours?”
“Fine.”
My kids would start watching the ensuing exchange like they were at a tennis match. One of my more perceptive daughters would holler, “Popcorn!” and hie away to the kitchen. All the kids knew that the trauma on one, or the other, or both sides would leak out somehow, and it would be fun to watch. Li’l heathens. They got that from their mother.
Also, when hubby is on call for judiciously applying mayhem and (to the uninitiated) what appears to be wanton destruction, and wifey-poo (she will literally kill me if she ever reads this and sees that I said that) is a member of an open heart team that is on call, when both beepers went off–literally simultaneously, at the worst time imaginable, every time–playing “rock, paper, scissors” to see who got to go into work immediately and who got to bundle the kids up to take to their on-call, 24/7 emergency babysitter, well it was just fun. Good times, good times. And I know that was a run-on sentence, but you had to be there. End aside]
Example 1: Some years ago, I had to have a laparoscopic procedure on my knee. I’d torn up the meniscus, and they went in and cleaned up all the flotsam and jetsam. They also shaved the back of my patella, as apparently said meniscus detritus had scarred it up pretty bad. Because US healthcare is freakin’ awesome, it was an out-patient procedure. Before I checked out, the last visit was from the provider’s physical therapist. He gave me some pretty generic tips, and then told me “you want to get off the crutches as soon as possible.“
Okay.
The procedure was on a Thursday. On Friday I gimped around on crutches. On Saturday, I decided it was time to sac up and kick the crutches habit. Done and done.
The next Monday, I had a follow-up appointment with the docs that had fixed my knee. Part of that was seeing the physical therapist. He walked in, looked around, and asked, “where are your crutches.”
“Got off ’em Saturday. You said get off them ASAP.”
“I meant in a couple of weeks! Not a couple of days!”
Well then, you should’ve said that. Victim of the Medical Bell Curve.
Example 2:
Not too long after I retired from the military (like, a couple of weeks) I got my Type II diabetes diagnosis. My primary care physician said, “take these pills (Metformin HCL), you can keep doing what you’re doing, and try to keep your blood sugars down.”
“Got it, Doc.”
Well, I didn’t keep doing what I was doing. I read everything I could about Type II and how to survive and thrive with the condition. I was knocking it out of the park. I was getting those blood sugar levels down.
But…
I mentioned to The Lovely and Talented Mrs. Mongo, three/four months in, “Man, this is the second training session in a row that I couldn’t spar. I was so exhausted, I was a safety hazard, to me or someone else.”
Herself said, “Well, you’re still keeping a journal of your blood sugar levels, right?”
“Affirmative.”
“Let me see your log.”
So, I have no idea whether the numbers are in parts per million, parts per billion, milliliters or centiliters. Bunch of metric stuff involved with Type II Diabetes. But, if you’re not fasting, a blood sugar count (again, no idea of the units) should be at/about 180. If you are fasting, should be at/about 120.
But I’d been told to get my blood sugar levels down as much as possible, per the doctor’s guidance. I was going for zero, baby.
The Lovely and Talented Mrs. Mongo reviewed my painstaking, day-by-day blood sugar log, and said, “Hey, dumbass, you know that any count below 70 is of medical concern, right?”
“Uh, no. No one mentioned that. So, I shouldn’t be proud of those entries that say 28? 32? 26?”
“No. Now go drink some orange juice right now.”
“But orange juice has a lot of sugar in it…”
“Did I sound like I was asking you?”
“No, my love. Getting orange juice on board time now, my love.”
***
I know my body.
I can tell, if I’m out in an austere environment, humping a heavy rucksack, the moment I go from burning fat to burning muscle, just by the smell.
I can tell, given the configuration of the shards of broken glass embedded in my shoulder, if this morning’s workout can have 20, 10, 5, or 1 pull-ups in it.
I can tell if some impingement or debility will just be a pain in the tuchus, or will hamper the odds of mission success.
I know my body.
Just saying.
Published in General
Yeah, had heartburn for months, treated it with OTC Nexium, which helped. Then I had a couple days of dark stools I passed off as the Chili I had for dinner. Finally tested it, and it was strong heme positive. Off to the ER. Ended up getting an EGD a couple days latter and they discovered the gastric band I had for weight control had eroded into my stomach and that was source of my bleed.
Semi emergent surgery, followed by a PE and a post op wound infection. All better now, off the Xarelto and wound finally healed. But it was a fun couple of months. I much prefer being on the other side of the table….
In defense of the doctor–and I’m not sure which is funnier, that he was trying shovel the snow off his roof or that he missed the fact that his spleen had ruptured–I had a ruptured spleen and I didn’t know it. It didn’t hurt. I fell on the floor at home, and my husband called an ambulance. I hadn’t been in an accident of any kind, and I don’t play football. (The only thing I can think of that I had been doing that weekend was pulling concrete pieces out from under a tree in my yard that wasn’t growing well. I was trying to give the roots some room to spread out, and I discovered it had been planted over someone’s old driveway. So I was lugging pieces of it around the yard. That’s probably when I punctured the spleen. The biopsy came back normal. There was nothing wrong with the spleen.)
All the ER doctors knew was that my blood pressure was dropping. They sent me for either a CT scan or an MRI, and the story was told to me later that all the technician saw was that my abdomen was filled with blood. She apparently pulled me out almost as soon as she had put me in. She grabbed an unlucky surgeon off the elevator who was on his way to his vacation. He saved my life–I hope I’ve done something useful with it–and then promptly went on his vacation. I didn’t meet him until two weeks later. :-)
My point is that I wasn’t in any pain at all from it. It probably wouldn’t have mattered whether your friend had had the Demerol or not. He still might not have known. :-) As injuries go, this one seems to evade the nervous system sensors somehow. :-)
It wasn’t that the patient didn’t realize he had ruptured his spleen, he had “distracting injuries”, the two broken wrists that the patient was focused on. The problem was the ER doc when he did the abdominal exam wasn’t able to tell he had an abdominal injury because the Demerol masked any abdominal tenderness he should have had with a ruptured spleen when it was palpated.
The funnier part of the story, to me anyway, and in keeping with the “I know my body” “No, you don’t” issue we’re discussing, when word got out to family members, friends, and coworkers of my fun day at the hospital, everyone who called or e-mailed asked, “What’s a spleen? Where is it? What does it do?” :-) :-) I too didn’t know anything about it until that day. :-)
But he knew his body.
On a slightly different note I’ll mention my own most recent doctor’s visit a few years ago. Actually this was a f/u visit with a PA (retired Army medic) after a bilateral inguinal hernia repair. The visit was for a wound problem. I spend three minutes talking about the wound, eight minutes talking about the latest conspiracy theories (he’s even more into it than I am), and two minutes being told what was to be done. And then, yes, he sent me to get an abdominal x-ray to see what’s going on, and to see if they left a chip in my belly or not. He’s a very understanding and agreeable PCP. He actually took me seriously about the chip (and there was no chip — very nice). :)
Follow-up:
OK, got through the check-up to find that my A1C was borderline (I did not fast for the bloodletting and ate two pieces of blueberry pie with vanilla ice cream the prior evening; not my fault – my wife passed through Rock Springs the day before.) My total cholesterol was good, but my bad cholesterol was 130, 1 point above “OK”. I admit it. I eat bacon or sausage and eggs every day. No cracks about my weight. The doc had very little to beat me up over, so he told me to watch my fat intake – limit my red meat, cheese and eggs. I told him about my egg habit and he suggested whites only, then admitted that whites are essentially congealed wallpaper paste. He obviously was not that concerned. Still, he’s following up in 3 mos to see if I’ve made any progress.
It’s all good.
Good.
What a great story, thanks. When I see a physician as a patient, at the first visit I say, “Treating physicians is hard for me. Therefore, I am going to treat you like any other patient. Please don’t think I am being condescending, I would rather tell you things that you know than assume you know things that you don’t”.
An ObGyn I know gave his wife a laxative for what turned out to be an ectopic pregnancy. Another Doc I know gave her internist hubby a laxative for what turned out to be small bowel obstruction. Both patients lived after urgent surgery.
Don’t treat your family for anything more serious than a hangnail. Just don’t.
Sometimes, oh Great Mongo, I doubt that you were in Special Forces or military operations or whatever the heck you did that allowed you to risk your life and blow things up for decades over the long haul, simply because you write like you have been doing it 6 hours a day for at least ten or twenty years.
(I only mention my doubting your bio as I know for a fact you live far enough away to not beat me up. Plus I’m female, and you do have a certain chivalrous air to you.)
I type. I file. I make wicked good coffee.
Well, do you normally view stomach pain / cramps as immediately requiring medical attention? I honestly figured most cases could be fixed with a Pepto-bismol, and if that does not work / things get worse then you get to the ER.
(By the way, I’m still waiting for that reference on reverse transcriptase activity in human cells. Don’t want you to be the only one not knocked down a peg here LOL)